Quality and Safety

The funding will span more than 20 projects to address several of healthcare’s biggest burdens, according to the Patient-Centered Outcomes Research Institute.

Project ECHO, a health IT pilot that launched in 2003 in rural New Mexico to connect rural doctors to specialists, is now front and center in Congress as lawmakers consider employing the model across the country. Senators Orrin Hatch, R-Utah, and Brian Schatz, D-Hawaii, introduced the Expanding Capacity for Health Outcomes Act this past week. The bill calls for studies on how best to expand the model. In New Mexico, Project ECHO has recorded unprecedented success in treating patients with hepatitis C. "Project ECHO has proven that technology can help overcome traditional barriers to adequate healthcare treatment, such as distance, income and lack of specialized medical professionals for underserved communities with no access to treatment," Sanjeev Arora, MD, project director, told Healthcare IT News back in 2008. [Also: IT employed in hepatitis-C fight in rural New Mexico] The initiative is underpinned by a Web-based application developed by Infosys Technologies. Project ECHO – it stands for Extension for Community Healthcare Outcomes – was funded by Agency for Healthcare Research and Quality, so the federal government already has a hand in the effort. "In states with large rural populations like Utah, it's vital that we do everything we can to ensure that patients have access to quality health care – no matter where they live," Hatch said in an April 29 statement posted on his website. "Our bill would help connect primary care providers in underserved areas with specialists at academic hubs, making it easier for medical professionals to access the continuing education they need and provide health care to more people," added Schatz. The bill requires the Department of Health and Human Services to work with the Health Resources & Services Administration to prioritize analysis of the model, its impacts on provider capacity and workforce issues, and evidence of its effects on quality of patient care. It calls on GAO to report on how increased adoption of a Project ECHO model might boost efficiencies and potential cost savings and improve healthcare. It also requires HHS Secretary Sylvia Burwell to submit a report to Congress on the findings of the GAO report and the HHS report, including ways such models have been funded by HHS and how to integrate the models into existing funding streams and grant proposals.

The sheer number and variety of providers that patients see after leaving a hospital make medical mistakes and poor transitions in care all too common today. 

Andrew Bindman, MD, will take the helm at the U.S. Agency for Healthcare Research and Quality. Under the umbrella of the Department of Health and Human Services, AHRQ is charged with finding ways to improve healthcare by making it more accessible, affordable, equitable – and safer.

On Twitter, former National Coordinator for Health IT Farzad Mostashari, MD, called it the "most substantive change to how healthcare is paid for in a couple of decades." The propsed MACRA rule put forth by the U.S. Department of Health and Human Services on Wednesday also holds some pretty big changes for how health IT can be put to work by physicians to drive quality improvement and cost efficiencies. [Also: MACRA proposed rule published by HHS, streamlining federal programs including meaningful use] "By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice and their patients," said Patrick Conway, MD, chief medical officer at the Centers for Medicare & Medicaid Services, in announcing the rule. "Reducing burden and improving how we measure performance supports clinicians in doing what they do best – caring for their patients." So far, most industry reaction to the notice for proposed rulemaking is positive – recognizing the fact CMS seems to have taken the feedback from more than 6,000 frontline healthcare stakeholders to heart, crafting a rule that's attuned to the needs of physicians. In a statement, HIMSS applauded the "significantly streamlined reporting and the acknowledgement process for MIPS-eligible clinicians" in the new rule. "We are encouraged by CMS's effort to coordinate reporting periods across federal programs and the decision to align with the ONC Interoperability and Certification Programs," HIMSS officials said. "With the first MIPS performance full-year reporting period expected to begin on January 1, 2017, we're further analyzing the MACRA rule to ensure that Medicare providers will be able to meet the proposed requirements." American Medical Association President Steven Stack, MD, meanwhile, said it's "hard to overstate the significance of these proposed regulations for patients and physicians." In particular, he was pleased that CMS has been listening to physicians’ concerns and "has made significant improvements, by recasting the EHR meaningful use program and by reducing quality reporting burdens." American Health Information Management Association CEO Lynne Thomas Gordon released a statement saying AHIMA supports the MIPS progam's "emphasis on interoperability, information exchange and security measures, which we believe are critical to reaching the rule’s stated long-term goal of ‘better care, smarter spending, and healthier people.'" The Premier healthcare alliance was less pleased, however – specifically taking issue with one part of the two-pronged MACRA approach to value-based care: its provisions related to advanced payment models, or APMs. CMS "made a significant mistake in not including any bundled payment or Track 1 Medicare Shared Savings Program ACOs as qualifying advanced payment models under MACRA," said Blair Childs, senior vice president of public affairs at Premier Inc. "Rather than rejecting bundled payment programs, we believe CMS should focus on ways to alter the bundled payment programs to demonstrate use of certified EHR technology and align measures with other Advanced APMs. "We also believe CMS seriously erred in excluding Track 1 MSSP ACOs in the APMs for failing to meet the more than 'nominal risk' financial requirement," said Childs. "As we've learned through members in our Population Health Management Collaborative, these programs require providers to not only forego revenue through a lower volume of services, but also investment millions of dollars in redesigning care through new technologies, data analytics, additional staff, etc.," he said. "We think most businessmen would call that more than nominal risk, yet CMS choses to define it as only cases where there is risk to the government." Elsewhere in the Twitterverse, the response was mostly positive – with some skepticism and a bit of I-told-you-so mixed in. And "Meaningful Use" is going "away" by changing its name to "Advancing Care Information" #MACRA #livetweeting as I read the proposed rule — Joy Rios (@askjoyrios) April 28, 2016 or basically what #MU should have been from day 1 @Travis_Broome — Harold Smith III (@haroldsmith3rd) April 28, 2016 1/Bottom Line #MACRA NPRM Game changer. Lots of great changes, 100's of thoughtful details and decisions. Biggest blind spot can be fixed — Farzad Mostashari (@Farzad_MD) April 27, 2016 Really good YouTube "whiteboard" connecting the dots of our MACRA announcement. Plain English. No acronyms. Wow. https://t.co/qLHSpYnWRX — Andy Slavitt (@ASlavitt) April 27, 2016 A tree died for this #MACRA #MIPS #Medicare pic.twitter.com/YsiSd3R9Mf — Amanda Narod (@AmandaBinDC) April 28, 2016

The U.S. Department of Health and Human Services issued a long-awaited proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, on Wednesday, ushering in some big changes for the ways physicians are assessed for quality of care and use of information technology.    

By and large, population health measurement efforts are poorly developed and uncoordinated – and without effective measurement success will remain elusive, says Georgetown's Michael A. Stoto.

Digital document kingpin Adobe has unveiled the first integration between Adobe Sign and Adobe Marketing Cloud. The integration is designed to eliminate costs and inefficiencies surrounding manual, paper-based processes for enrolling and services, including healthcare enrollment, registration and services. Adobe Sign, formerly known as Document Cloud eSign, now features an upgraded and modernized mobile app experience and works in a seamless fashion with Adobe Experience Manager Forms, a key component of Adobe Marketing Cloud. Adobe said this can help an organization go completely digital with anything from credit card applications to government benefit forms to medical forms. Adobe also has announced new Document Cloud storage integrations with Box and Microsoft OneDrive. These integrations are designed to make it easier to access and work on PDF files from anywhere. "Adobe has led the global standard in secure digital documents with the PDF format, and we are working toward the same thing with secure and reliable signatures," said Lisa Croft, group product marketing manager for Document Cloud at Adobe. "And related to Adobe Sign, we are announcing the first integration across the Adobe Marketing Cloud, because we are focused on helping customers deliver good experiences for their customers." Croft cited healthcare as an example, where organizations need, for instance, to digitally obtain information from a patient. "That journey can be a big challenge, to serve the patient appropriately and set everything up," she added. "This new integration is meant to make all of that easier." Tools within Adobe Marketing Cloud can ease the creation of forms with many multiple data fields, and make completing such forms an easier task, Croft said. "In a lot of cases today, healthcare organizations still have to print forms to gather signatures," she said. "With our new integration, we have been able to make that process 100 percent digital. Take all the data and flow it into a final version of a form and then Sign can electronically capture a signature – nothing has to be printed. A healthcare organization can do the whole patient onboarding process without having to print a document."

Truven Health Analytics prides itself on, well, analyzing data. So when it came to picking this year’s top 15 hospitals, Truven analysts turned to crunching numbers. The winning health systems are those who showed higher survival rates and fewer errors at a lower overall treatment cost than any of the other health systems across the country. Overall mortality rates were 14.7 percent lower than non-winning peer group hospitals Complication rates were 15.1 percent lower ED wait times were 12.3 percent lower. The 15 health systems also lowered cost per episode by 5 percent, discharged patients from the hospital a half-day sooner than non-winners. Moreover, they showed y percent higher Patient Satisfaction Scores compared with the non-winning hospitals. The 2016 edition of 15 Top Health Systems evaluated 338 health systems and 2,912 member hospitals to identify the systems with the highest overall achievement on a balanced scorecard. Here are the winners: Large Health Systems (operating expense of more than $1.75 billion) Mayo Foundation – Rochester, Minn. Mercy – Chesterfield, Missouri Spectrum Health – Grand Rapids, Michigan Sutter Health – Sacramento, California Sutter Health Valley Division – Sacramento, California Medium Health Systems (operating expense between $750 million and $1.75 billion) Kettering Health Network – Dayton, Ohio Scripps Health – San Diego, California St. Luke's Health System – Boise, Idaho St. Vincent Health – Indianapolis TriHealth – Cincinnati, Ohio Small Health Systems (operating expense of less than $750 million) Asante – Medford, Oregon Lovelace Health System – Albuquerque, New Mexico MidMichigan Health – Midland, Michigan

An estimated 33,439 lives could be saved each year if all hospitals had the same performance as those receiving an A grade, according to Leapfrog and the Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality.